S He1, Y L Wang, Z L Zuo. 1. Department of Pediatric Intensive Care Unit, Children's Hospital of Chongqing Medical University, Ministry of Education Key Laboratory of Child Development and Disorders, China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
Abstract
Objective: To evaluate the clinical application of Chinese version of Cornell assessment of pediatric delirium (CAPD) scale in children by a pilot study. Methods: A prospective observational study. From June 2017 to December 2017, the original CAPD screen was translated into Chinese and debugged cross-culturally according to the guidelines, which was further applied in the Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University. The clinical data of 250 patients who were evaluated with the Chinese version of CAPD scale and Richmond agitation-sedation scale were extracted and analyzed with chi-square test or Mann-Whitney U test. Cronbach's α coefficient,Split-half coefficient and intra-group correlation coefficient were used to evaluate the reliability, while exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the structural validity of the scale. The result was compared with the gold standard diagnostic results to evaluate the diagnostic efficacy of the CAPD. Results: Sixty-one (24.4%) patients had delirium during pediatric intensive care unit hospitalization,and significant differences existed between them and 189 patients without delirium in age (χ(2)=11.220, P=0.011), rates of mechanical ventilation (χ(2)=6.691, P=0.010) and length of PICU hospitalization (Z=10.656, P=0.001). The Chinese version of the CAPD scale had high discrimination among the 8 items in the main table without skewed distribution and discrete items. The internal and external reliability of the scale were preferable as the Cronbach's α coefficient was 0.819 and ICC value was 0.835. The KMO value of EFA was 0.834 and Bartlett spherical test showed statistical significance (χ(2)=661.440, P<0.01). CFA constructed a two-factor structural equation model with favorable fit index:Chi-square/degree of freedom (DF) ratio was 1.786 (χ(2)=33.930, P=0.019), goodness of fit index (GFI) was 0.967,adjusted GFI was 0.938,root mean square of the approximate error (RMSEA) was 0.056. A good diagnostic efficacy of this scale was demonstrated by receiver operating characteristic curve analysis as when the cut-off was 10, the area under curve was 0.99 (95%CI: 0.97-0.99), sensitivity was 96.7% (95%CI: 88.7-99.6), specificity was 93.1% (95%CI: 88.5-96.3), positive likelihood ratio was 14.0 (95%CI: 13.2-14.9), and the negative likelihood ratio was 0.035 (95%CI: 0.008-0.200). Conclusion: The Chinese version of the CAPD Scale has favorable reliability,validity,diagnostic efficacy, as well as feasibility, which should be applied in evaluation of pediatric delirium in clinical observation and research in the future.
Objective: To evaluate the clinical application of Chinese version of Cornell assessment of pediatric delirium (CAPD) scale in children by a pilot study. Methods: A prospective observational study. From June 2017 to December 2017, the original CAPD screen was translated into Chinese and debugged cross-culturally according to the guidelines, which was further applied in the Department of Critical Care Medicine, Children's Hospital of Chongqing Medical University. The clinical data of 250 patients who were evaluated with the Chinese version of CAPD scale and Richmond agitation-sedation scale were extracted and analyzed with chi-square test or Mann-Whitney U test. Cronbach's α coefficient,Split-half coefficient and intra-group correlation coefficient were used to evaluate the reliability, while exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were used to evaluate the structural validity of the scale. The result was compared with the gold standard diagnostic results to evaluate the diagnostic efficacy of the CAPD. Results: Sixty-one (24.4%) patients had delirium during pediatric intensive care unit hospitalization,and significant differences existed between them and 189 patients without delirium in age (χ(2)=11.220, P=0.011), rates of mechanical ventilation (χ(2)=6.691, P=0.010) and length of PICU hospitalization (Z=10.656, P=0.001). The Chinese version of the CAPD scale had high discrimination among the 8 items in the main table without skewed distribution and discrete items. The internal and external reliability of the scale were preferable as the Cronbach's α coefficient was 0.819 and ICC value was 0.835. The KMO value of EFA was 0.834 and Bartlett spherical test showed statistical significance (χ(2)=661.440, P<0.01). CFA constructed a two-factor structural equation model with favorable fit index:Chi-square/degree of freedom (DF) ratio was 1.786 (χ(2)=33.930, P=0.019), goodness of fit index (GFI) was 0.967,adjusted GFI was 0.938,root mean square of the approximate error (RMSEA) was 0.056. A good diagnostic efficacy of this scale was demonstrated by receiver operating characteristic curve analysis as when the cut-off was 10, the area under curve was 0.99 (95%CI: 0.97-0.99), sensitivity was 96.7% (95%CI: 88.7-99.6), specificity was 93.1% (95%CI: 88.5-96.3), positive likelihood ratio was 14.0 (95%CI: 13.2-14.9), and the negative likelihood ratio was 0.035 (95%CI: 0.008-0.200). Conclusion: The Chinese version of the CAPD Scale has favorable reliability,validity,diagnostic efficacy, as well as feasibility, which should be applied in evaluation of pediatric delirium in clinical observation and research in the future.